With more and more ‘walk-in’ laser-surgery centres opening up, the emphasis is on the benefits; very few mention the possible risks either in their advertisements or during the face-to-face consultations before the operation.

The Advertising Standards Authority, the UK’s advertising watchdog, upheld complaints against misleading advertising for LASIK surgery which had been produced by Boots, Maxivision and Optimax, some of the leading players in this lucrative field.

Such a misleading approach was a major concern of the patients, according to a poll conducted by HealthWhich? earlier this year. Some complications that doctors deemed ‘minor’ can seriously affect people’s lives and jobs. One patient complained she could no longer drive and now fails to recognise people who are just 10 feet away. But because she can still read an eye chart, her problem is not considered significant, the poll said.

Some patients whose lives have been ruined by eye surgery have taken on the task of providing a health warning to potential patients, and also provide help to those already affected. The Surgical Eyes Foundation (website: www.surgicaleyes.org) is a US-based support group for people with 'longer-term complications from refractive surgery'. Their aim is 'to restore quality of life to the thousands who suffer from complications of . . . refractive surgeries'.

Others are much more militant. In the UK, the Medical Defence Union, the biggest insurer of British doctors, said claims against surgeons performing laser eye operations are soaring - mainly because the expectations of the patients don’t match their results. The MDU said doctors needed to warn patients of the possibility of an 'imperfect result and other complications' before obtaining the appropriate consent for the procedure (The Guardian, 26 May 2003).

Unrealistic expectations, or perhaps expectations that have been put in the patient’s mind by advertisements or during the preoperative discussions, could be at the heart of the issue. Even if you are among those who suffer no reactions or complications after surgery, you are still likely to need to wear glasses for some tasks, eye surgeon David Gartry told the BBC News (26 May 2003).

Quality of treatment can vary enormously from one clinic to another. Yet, this information is rarely, if ever, made available to patients choosing where to have their treatment.

Extraordinarily, any currently registered doctor can offer laser eye surgery without the need for any special, formal qualifications. In the main, surgeons receive just two or three days of training at best - and then go on to develop and perfect their skills on you, the patient. Britain’s Royal College of Ophthalmologists recommends that refractive surgeons should be fully trained ophthalmologists and should have undergone additional specialist training; they suggest that prospective patients should ask about this when enquiring about surgery. Laser eye surgery is an immature technique that is still being developed, and one that is being carried out by surgeons who are still learning their craft.

Surgery: what’s involved
Lasers have been used in eye surgery for some time, but they have only been in widespread use since the beginning of the 1990s. Before that time, the eye surgeon needed supreme skill and confidence with a scalpel.

When lasers are used to treat myopia (shortsightedness), the shape of the cornea is finely sculpted to allow the eye to focus better. The central part of the cornea is flattened, which brings the focal point of the eye closer to the retina, allowing distance vision to be improved. The surgery removes microscopic amounts of tissue from the outer surface with a cool, computer-controlled ultraviolet beam of light. The beam is so precise that it can cut notches in a strand of human hair without breaking it. Each pulse can remove 39 millionths of an inch of tissue in 12 billionths of a second.

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